EP0095396A1 - External upright position and walking apparatus for the lower-limbs motorically handicapped - Google Patents

Abstract

1. An external apparatus for the vertical stance and walking for persons with motor handicaps in one or both lower limbs, the said apparatus comprising in combination : - a single shell corser disposed at the level of the pelvic girdle ; - a brace associated with each limb to be equipped, the said brace comprising ; - on the one hand, an external femoral element disposed parallel to the external side of the femur and substantially over all its length, the said element having its upper end joined to the corset near the iliac crest by a means which is disposed substantially in the extension of the element and which is fixed to the said corset ; - and, on the other hand, a tibial element disposed on the internal side of the tibia and substantially over all its length, the said element being joined to the femoral element, at the level of the knee, by a connecting member allowing their relative movements ; wherein - the external femoral element is a spring lever comprising a strip of flexible metal capable of absorbing and restoring the flexural and torsional stresses ; - the tibial element is an antero-internal spring lever comprising a strip of flexible metal capable of absorbing and restoring the flexural and torsional stresses - the connecting member is a knee cap capable of maintaining the relative movement between the thigh and leg in slight flexion and slight valgus, within the narrow limits of the physiological articular play, thanks to elastic elements disposed on the internal side and on the external side of the knee, between the zones of the knee cap situated above and below the articulation, both on its frontal side and on its posterior side ; - the means joining the femoral spring lever to the corset is a first elastic strap, the said femoral spring lever being additionally joinded to the corset by a second elastic strap which extends transversely whilst being slightly inclined towards the top to be fixed on the corset towards or in the direction of the iliac spines, the said second strap thus substantially crossing the public symphisis ; - the knee cap is rigidly joined, on the one hand, in its upper zone, to the lower end of the femoral spring lever and, on the other hand, in its lower zone to the upper end of the tibial spring lever ; - the lower end of the tibial spring lever is rigidly joined to an element limiting the articular play of the tibial-tarsal articulation, the said element (7) being an orthopaedic shoe which comprises ; - a semi-rigid shell (70) surrounding the foot and the lower tibial conus, this shell comprising an opening (71) which extends opposite the antero-external loculus of the tibila conus and opposite the external edge of the foot, above the cuboid and at least one metatarsal zone, the said shell carrying in the zone of the internal malleolus an attachment point (72) for the lower end (6b) of the tibial spring lever (6) ; - an elastic brace comprising on the one hand, a spring lever (73) joined to the shell (70) and disposed vertically opposite the fibula from the external side of the calcaneus as far as the zone of the upper edge (702) of the shell (70) and, on the other hand, regulating elastic means (74, 75, 77) fitted outside the shell firstly, from the internal edge (701a) of the sole (701) of the shell (70) toward the upper portion (703) of the vamp and towards the upper edge (702) of the trunk of shell (70) and secondly, from the attachment point (72) of the tibial spring lever (6), as far as the postero external zone (701c) of the heel of sole (701) ; - and closing means (76, 76a, 78) for the shell (70) of the shoe.

Description

European patent application n ° 0 066 028 relates to an autonomous external apparatus which allows the vertical station and the locomotion of the physically handicapped of one or both lower limbs, this apparatus being contained by a removable para-skeleton and light allowing at the same time to compensate for the insufficiency of the postural tone and to reconstitute the physiological mechanism of the podal support and walking.

• a) un corset monocoque à hauteur de la ceinture pelvienne, suffisamment développé en hauteur pour rendre solidaire le centre de gravité corporel et les membres inférieurs ;
• b) parallèlement à la face externe du fémur et sensiblement sur sa longueur, un élément métallique, léger et flexible, susceptible d'encaisser et de restituer les contraintes de flexion et de torsion pour former un levier-ressort fémoral externe ;
• c) un levier-ressort métallique, léger et flexible, susceptible d'encaisser et de restituer les contraintes de flexion et de torsion et disposé parallèlement à la face antéro-interne du tibia, sensiblement sur toute sa longueur;
• d) une sangle latérale verticale élastique reliant ledit ressort fémoral externe audit corset, et des sangles élastiques transversales se croisant en X, une pour chaque levier-ressort fémoral reliant chacune un ressort fémoral audit corset ;
• e) au niveau du genou, un ensemble d'éléments muni de sangles élastiques limitant le flexum, le valgum, le récurvatum et la rotation interne dans les limites étroites du jeu articulaire physiologique ;
• f) une chaussure, notamment orthopédique, reliée audit levier-ressort tibial pour le positionnement de l'articulation tibio-tarsienne dans les limites d'un jeu physiologique normal.

This para-skeleton includes:

• a) a monocoque corset at the height of the pelvic girdle, sufficiently developed in height to make the body center of gravity and the lower limbs united;
• b) parallel to the external face of the femur and substantially along its length, a metallic element, light and flexible, capable of absorbing and restoring the bending and torsional stresses to form an external femoral spring lever;
• c) a light and flexible metal spring lever capable of absorbing and restoring the bending and torsional stresses and arranged parallel to the antero-internal face of the tibia, substantially over its entire length;
• d) an elastic vertical lateral strap connecting said external femoral spring to said corset, and transverse elastic straps crossing in X, one for each femoral spring lever each connecting a femoral spring to said corset;
• e) at the knee, a set of elements provided with elastic straps limiting flexum, valgum, recurvatum and internal rotation within the narrow limits of physiological joint play;
• f) a shoe, in particular an orthopedic shoe, connected to said tibial spring lever for positioning the arti tibio-tarsal culation within the limits of normal physiological play.

This apparatus realizes, in fact, a real inversion of the physiological system of the lower limb and, thanks to it, an automatic walk becomes possible by means of the voluntary displacement of the center of gravity of the body behind and laterally, like a "pelvic motor".

the monocoque corset, little or not deformable, ensures a semi-rigidity of the lower part of the trunk and makes it possible to ensure the motor movement by the displacement of the part of the trunk situated above the corset, the latter also having the role of 'Improving the connection between the part of the apparatus extending parallel to the femur and the pelvis, in particular at the level of the iliac wings.

The knee brace, which is capable of holding the knee joint in slight flexum and light valgum, by means of a system of elastic straps suitably arranged to form elastic brakes for recurvatum, varum, valgum and flexum, is also designed to constitute a brake on internal and external rotations and to have a tendency to favor internal rotation thus stabilizing the femoral head to ensure a refocusing at each step, the lower limb being, in fact, stressed in internal screw during its movement.

The applicant, to improve the functioning of the apparatus according to his aforementioned patent application, has developed an orthopedic shoe which allows the physiological functioning of the podal support by comforting and regulating an internal screw movement.

• - une coque semi-rigide entourant le pied et le cône inférieur jambier, cette coque comportant une ouverture, qui s'étend en regard de la loge sntéro-externe du cône jambier et en regard du bord externe du pied au-dessus du cubotde et d'au moins un rayon métatarsien, ladite coque portant, dans la zone de la malléole interne, un point d'attache de l'extrémité inférieure du levier-ressort tibial de l'appareillage ;
• - une armature élastique comportant, d'une part, un levier-ressort lié à la coque et disposé verticalement en regard du péroné, depuis la face externe du calcanéum jusqu'à la zone de bordure supérieure de la coque, et, d'autre part, des moyens élastiques régulateurs implantés à l'extérieur de la coque, en premier lieu, à partir du bord interne de la semelle de la coque vers la partie supérieure de l'empeigne et, vers la bordure supérieure de la tige de la coque et, en second lieu, à partir du point d'attache du levier-ressort tibial jusqu'à la zone postéro-externe du talon de la semelle ;
• - et des moyens de fermeture de la coque de la chaussure.

The present invention therefore relates to the new industrial product that constitutes an external device for a vertical station and a step for the disabled with one or two lower limbs, of the type defined in the main patent application and mentioned above; this apparatus being characterized in that the element limiting the articular play of the tibio-tarsal joint is an orthopedic shoe comprising:

• a semi-rigid shell surrounding the leg and the lower leg cone, this shell comprising an opening, which extends opposite the stero-external compartment of the leg cone and opposite the external edge of the leg above the cubotde and at least one metatarsal radius, said shell carrying, in the region of the internal malleolus, a point of attachment of the lower end of the tibial spring lever of the apparatus;
• - an elastic reinforcement comprising, on the one hand, a spring lever linked to the shell and disposed vertically opposite the fibula, from the external face of the calcaneus to the upper border area of the shell, and, on the other hand hand, elastic regulating means implanted outside the hull, firstly, from the internal edge of the sole of the hull towards the upper part of the vamp and, towards the upper edge of the stem of the hull and, secondly, from the point of attachment of the tibial spring lever to the postero-external zone of the heel of the sole;
• - And means for closing the shell of the shoe.

Advantageously, the means for closing the shell comprise an elastic means stretched between the internal edge of the sole of the shell, at the level of the first metatarsal, and the external edge of said sole at the level of the cubotde; optionally, the means for closing the shell can comprise elastic means stretched between the internal edge of the sole of the shell, at the level of the first metatarsal, and the external edge of said sole at the level of the fifth metatarsal; at the end of the foot, the opening of the shell extends transversely above the last two metatarsals; the shell surrounds the lower cone leg to the top of the lower third of the leg and the closure means comprise a tightening band extending all along the upper edge of the shell rod; the shell of the shoe can be made in one piece from molded plastic; the shoe can internally include a foot support sole molded to the reliefs of the arch of the user placed in a vertical equilibrium position.

The spring lever, linked to the shell of the shoe and arranged vertically opposite the fibula, may be a hardened steel blade 40 mm wide and approximately 1 mm thick: this spring lever regulates the movements of internal inclination (rolling and lowering of the calcaneus) and internal screw movements of the leg segment on the tibio-tarsal and subtalar joints. The elastic regulating means, which are associated with this lever-spring of the shell, regulate the actions of the lever-spring of the shell and of the internal tibial spring-lever. It has been found that this particular architecture of the shoe makes it possible to withstand slight deformations in movement of the internal screw and to elastically restore the forces: this results in a slight physiological flexion of the ankle as well as an unfolding of the podal step (heel- outer edge-inner edge).

The present application for an addition certificate specifies, in addition, a certain number of particularities relating to the various structural elements of the apparatus described in the main patent application.

Thus, the two elastic straps connecting the upper end of the external femoral lever and the corset, respectively, in the vicinity of the iliac crest and in the direction of the iliac spines, can be of adjustable length.

Likewise, advantageously, the external femoral spring lever extends between an upper end under trochanteric and a lower end disposed substantially above the femoral condyle, and the tibial spring lever, in the anterior-internal position, advantageously extends between an upper end disposed under the tibial plateau and a lower supra-malleolar end. An appropriate prestress, for example a few deci-Newtons, can be applied to the spring levers, depending on the state of the subject's postural tone.

The kneepad preferably forms a single flexible piece made up of three parts: a lower femoral cone, an upper tibial cone and a para-patellar cone between the two previous ones. One could also consider making this toggle in two or three separate elements connected together by suitable means, preferably elastic.

In addition, as indicated in the main patent application, the knee brace comprises a plurality of straps constituting brakes to the recurvatum, varum, valgum, flexum, as well as to the internal and external rotations. These straps are preferably adjustable so as to adapt the kneepad to each specific case to maintain the joint normally in slight flexum and slight valgum. The flexum can be, for example of the order of 120 to 160 ° and, advantageously, be such that in the state of rest, when the subject is standing, the tibial plateau forms with the horizontal plane an angle towards down and forward which is not less than 5 °. Likewise, the angle of the valgum plate is preferably equal to or greater than 5 ° relative to the horizontal.

For example, for a 40 kg subject, the tension of the elastic straps of the apparatus may be close to 0.6 Newton.

The elastic straps of the apparatus or the elastic bands of the shoes of said apparatus can not only be made of elastic fabrics or rubber bands, but they can also be made with any element likely to exert an elastic tension between the two attachment points of these straps or bands; one could consider making them using non-elastically deformable parts connected together by an element capable of regulating the tension between these parts, for example by appropriate electronic or mechanical means.

Other advantages and characteristics of the invention will appear on reading the following description, given by way of nonlimiting example with reference to the appended drawing.

• - la figure 1 représente, en perspective, le détail d'une chaussure de l'appareillage selon l'invention, vue du côté interne ;
• - la figure 2 représente, en perspective, la chaussure de la figure 1 vue du côté externe.

On this drawing :

• - Figure 1 shows, in perspective, the detail of a shoe of the apparatus according to the invention, seen from the internal side;
• - Figure 2 shows, in perspective, the shoe of Figure 1 seen from the external side.

In the drawing, there is shown the tibial spring lever 6 of the apparatus according to the invention. This spring lever 6, which is inserted on the kneepad in the antero-internal position, extends along the tibial shaft to its lower end 6b, at the level of the internal malleolus, where it is fixed on the rising rod orthopedic shoe 7.

The shoe 7 consists of a shell 70 of molded plastic with a thickness of 3 mm, for example of low density polyethylene (d = 0.95). This shell, made in one piece, consists of a sole 701 surmounted by a vamp, the upper part of which has been designated by 703 and by a rod, the upper edge of which 702 is intended to lie slightly above of the lower third of the leg. The rod and the vamp of the semi-rigid shell 70 have an opening 71 which extends vertically on the rod opposite the antero-external compartment of the leg cone intended to be placed there and which extends over the vamp opposite the outer edge of the foot above the cubotde; the front end of this opening 71 is arranged transversely above the last two metatarsal rays. The shell 70 carries in the area of the internal malleolus, an attachment point 72 intended to fix the lower end 6b of the tibial spring lever 6 of the apparatus according to the invention. The opening 71 allows easy accommodation of the foot and the lower leg cone in the shell 70. In addition, this opening gives a degree of freedom, which ensures the dynamic balance of the movement of the disabled foot. Inside the shell 70, on the sole 701, there is a support sole (not visible in the drawing) molded to the reliefs of the subject's arch in the position of vertical equilibrium.

The shoe according to the invention comprises a frame inserted on the shell and comprising a spring lever 73 and elastic regulating means 74, 75 and 77.

The spring lever 73 is linked to the shell 70 at least by its two ends. In the embodiment described, the spring lever 73 is bonded externally to the shell 70 by its two ends; it consists of a hardened steel blade 40 mm wide by 1 mm thick. Alternatively, one could set up this insert spring lever in the shell 70 at the time of molding of this shell. The spring lever 73 is arranged vertically opposite the fibula from the external face of the calcaneus to the upper edge zone 702 of the shell: it is visible in FIG. 1.

The elastic regulating means consist of a plurality of elastic bands, which compensate and regulate the actions of the spring lever 73 and the tibial spring lever 6. An elastic band 74 is stretched from a point located at the level of the sole 701 in the postero-internal dial from the heel to the upper edge 702 of the stem of the shell 70. The band 74 makes an angle of approximately 30 ° with the vertical; it constitutes an elastic brake regulating the movements of the internal face of the shoe and promoting the movements of the internal screw. An elastic band 75 is disposed from the same point of the internal edge 701a of the sole 701; it extends to the point of implantation 72 of the tibial spring lever 6 and constitutes an elastic brake regulating the action of the spring lever 6 on the shoe 7. An elastic band 77 is stretched between the point of attachment 72 of the spring lever 6 and a point located in the postero-external zone 701c of the external edge 701b of the sole 701; this elastic band 77 also acts as a means of closing the shoe, since it passes over the opening 71 at the instep.

The shoe 7 further comprises closing means, some of which also act as an elastic brake during movement. In this regard, an elastic band 76 is stretched between a point located on the inner edge 701a of the sole 701, facing the first metatarsal, and a point located on the outer edge 701b of the sole 701, at the outer edge of the cuboid; this elastic band 76 regulates the movements of the upper part 703 of the upper of the shoe and at the same time ensures the closing of the shoe, since it is arranged transversely relative to the opening 71. It is possible, without this is compulsory, put in place another elastic band 76a, which starts from the same point of the internal border 701a as the elastic band 76 and which goes to a point of the external border 701b of the sole 701 situated opposite the fifth metatarsal. The upper part of the stem of the shell 70 is closed by a tightening band 78 disposed along the edge 702. Finally, a band 79 disposed all around the sole 701 encloses all the insertion points of elastic means arranged at the level of the sole 701. All the elastic bands appearing in the constitution of the shoe 7 advantageously have an adjustable length so as to be adjusted to the characteristics of the subject, who uses the apparatus.

It is found that the use of such a shoe allows a slight physiological flexion of the ankle during the movement of the subject as well as an unrolling of the podal step (heel-outer edge-inner edge).

Although the invention has been described in connection with a particular embodiment, it is understood that it is in no way limited thereto and that it can be made various modifications of shape and material, without this s 'move away neither from its frame, nor from its spirit.

Claims (10)

1. External apparatus for vertical and walking stations for the physically handicapped of one or both lower limbs, comprising: - a monocoque corset placed at the height of the pelvic girdle; - parallel to the face of the femur and along its length, an external femoral spring lever comprising a flexible metal blade capable of absorbing and restoring the bending and torsional stresses; - at the knee, a knee brace capable of maintaining the relative movements between the thigh and the leg in slight flexum and slight valgum, within narrow limits of physiological joint play; - parallel to the antero-internal face of the tibia and over its entire length, an antero-internal tibial spring lever comprising a flexible metal blade capable of absorbing and restoring the bending and torsional stresses; the upper end of the external femoral spring lever being connected to a first elastic strap substantially in the extension of the lever and fixed to said corset in the vicinity of the iliac crest, as well as to a second elastic strap extending transversely while being slightly inclined upward to attach to the corset towards or in the direction of the iliac spines, said second strap thus substantially crossing the pubic symphysis, while the lower end of the femoral spring lever is connected to the toggle to which is also connected to the the upper end of the tibial spring lever, the lower end of which is connected to an element limiting the articular play of the tibio-tarsal joint,
characterized in that the element limiting the articular play of the tibio-tarsal joint is a orthopedic shoe (7) comprising: - a semi-rigid shell (70) surrounding the foot and the lower leg cone, this shell comprising an opening (71), which extends opposite the antero-external compartment of the leg cone and opposite the external edge of the foot , above the cuboid and at least one metatarsal radius, said shell carrying in the region of the internal malleolus an attachment point (72) of the lower end (6b) of the tibial spring lever (6); - an elastic reinforcement comprising on the one hand, a spring lever (73) linked to the shell (70) and arranged vertically opposite the fibula, from the external face of the calcaneus to the upper border area (702) of the shell (70), and, on the other hand, elastic regulating means (74, 75, 77) located outside the shell, firstly, from the internal edge (701a) of the sole (701 ) from the shell (70) to the upper part (703) of the upper and to the upper edge (702) of the shell rod (70), and secondly, from the point of attachment (72 ) from the tibial spring lever (6) to the postero-external zone (701c) of the heel of the sole (701); - And closing means (76, 76a, 78) of the shell (70) of the shoe. 2. Apparatus according to claim 1, characterized in that the means for closing the shell (70) comprise an elastic means (76) stretched between the internal edge (701a) of the sole (701) of the shell (70) , at the level of the first metatarsal, and the outer edge (701b) of said sole, at the level of the cubotde. 3. Apparatus according to one of claims 1 or 2, characterized in that the means for closing the shell (70) comprise an elastic means (76a) stretched between the internal edge (701a) of the sole (701) of the shell (70), at the level of the first metatarsal, and the external edge (701b) of said sole, at the level of the fifth metatarsal. 4. Apparatus according to one of claims 1 to 3, characterized in that at the end of the foot, the opening (71) of the shell (70) extends transversely above the last two metatarsals. 5. Apparatus according to one of claims 1 to 4, characterized in that the shell (70) surrounds the lower leg cone to the top of the lower third of the leg and that the closure means comprise a tightening band ( 78) extending all the way along the upper edge (702) of the shell rod (70). 6 - Apparatus according to one of claims 1 to 5, characterized in that the shell (70) of the shoe (7) is made in one piece from molded plastic. 7 - Apparatus according to one of claims 1 to 6, characterized in that the shoe (7) internally comprises a sole for supporting the foot, molded to the reliefs of the arch of the user placed in a vertical equilibrium position . 8 - Apparatus according to one of claims 1 to 7, characterized in that the tibial spring lever extends between an upper end substantially sub-articular and a lower end substantially supra-malleolar. 9 - Apparatus according to one of claims 1 to 8, characterized in that an appropriate prestressing is applied to the spring levers, according to the state of the postural tone of the subject. 10 - Orthopedic shoe as defined in one of claims 1 to 7.

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